Basic Information
| Provider Information | |||||||||
| NPI: | 1790803328 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CITICARE INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 159 W 127TH ST | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100273723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2127493507 | ||||||||
| FaxNumber: | 2126661679 | ||||||||
| Practice Location | |||||||||
| Address1: | 159 W 127TH ST | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100273723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2127493507 | ||||||||
| FaxNumber: | 2126661679 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2007 | ||||||||
| LastUpdateDate: | 12/03/2008 | ||||||||
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| AuthorizedOfficialLastName: | UMUKORO | ||||||||
| AuthorizedOfficialFirstName: | SILVA | ||||||||
| AuthorizedOfficialMiddleName: | FRANKLIN | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2127493508 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | MBA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QC1500X | 7002299R | NY | Y | Ambulatory Health Care Facilities | Clinic/Center | Community Health |
No ID Information.